As opposed to traditional, open spine surgery which involves cutting or stripping the muscles from the spine, it has become common to perform spinal surgery using minimally invasive techniques, a treatment that involves small incisions and muscle dilation, allowing the surgeon to gently separate the muscles surrounding the spine rather than cutting them.
Spinal fusion procedures, such as minimally invasive Lateral Interbody Fusion (XLIF and DLIF), minimally invasive Posterior Lumbar Interbody Fusion (PLIF), minimally invasive Transforaminal Lumbar Interbody Fusion (TLIF), and minimally invasive Posterior Thoracic Fusion are often recommended as a surgical treatment option for patients with a condition causing spinal instability in their lower back, such as degenerative disc disease, spondylolisthesis or spinal stenosis.
In performing such a procedure the surgeon will make a small incision in the skin of the back over the vertebra(e) to be treated. Depending on the instrumentation to be used, the incision could be as small as approximately 3 centimeters. The muscles surrounding the spine will then be dilated to allow access to the section of spine to be stabilized. After the spine is accessed, the lamina (the “roof” of the vertebra) is removed to allow visualization of the nerve roots. The facet joints, which are directly over the nerve roots, may sometimes be trimmed to give the nerve roots more room.
The surgeon will then move the nerve roots to one side and remove disc material from the front (anterior) of the spine. Bone graft material, designed to serve as a bridge, or scaffold is then inserted into the disc space. Screws and rods may then be inserted, if necessary, to stabilize the spine while the treated area heals and fusion occurs. Fusing of the bone graft with the bones of the spine will provide a permanent union between those bones. Bone grafts may be taken from the hip or from another bone in the same patient (autograft) or from a bone bank (allograft). Bone graft extenders and bone morphogenetic proteins (hormones that cause bone to grow inside the body) can also be used to reduce or eliminate the need for bone grafts. The ultimate goal of the procedure is to restore spinal stability.